Neuropathic symptoms with SARS-CoV-2 vaccination (Safavi et al., 2022)

Pyrrhus

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Neuropathic symptoms with SARS-CoV-2 vaccination (Safavi et al., 2022)
https://www.medrxiv.org/content/10.1101/2022.05.16.22274439v1

A pre-print from Avi Nath and NIH colleagues about people who developed neurological symptoms after the coronavirus vaccine:
Background and Objectives
Various peripheral neuropathies, particularly those with sensory and autonomic dysfunction may occur during or shortly after acute COVID-19 illnesses. These appear most likely to reflect immune dysregulation. If similar manifestations can occur with the vaccination remains unknown.

Results
In an observational study, we studied 23 patients (92% female; median age 40years) reporting new neuropathic symptoms beginning within 1 month after SARS-CoV-2 vaccination.

100% reported sensory symptoms comprising severe face and/or limb paresthesias, and 61% had orthostasis, heat intolerance and palpitations.

Autonomic testing in 12 identified seven with reduced distal sweat production and six with positional orthostatic tachycardia syndrome.

Among 16 with lower-leg skin biopsies, 31% had diagnostic/subthreshold epidermal neurite densities (≤5%), 13% were borderline (5.01-10%) and 19% showed abnormal axonal swelling.

Biopsies from randomly selected five patients that were evaluated for immune complexes showed deposition of complement C4d in endothelial cells.

Electrodiagnostic test results were normal in 94% (16/17).

Together, 52% (12/23) of patients had objective evidence of small-fiber peripheral neuropathy.

58% patients (7/12) treated with oral corticosteroids had complete or near-complete improvement after two weeks as compared to 9% (1/11) of patients who did not receive immunotherapy having full recovery at 12 weeks.

At 5-9 months post-symptom onset, 3 non-recovering patients received intravenous immunoglobulin with symptom resolution within two weeks.

Conclusions
This observational study suggests that a variety of neuropathic symptoms may manifest after SARS-CoV-2 vaccinations and in some patients might be an immune-mediated process.
 

Pyrrhus

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Very interesting @Pyrrhus! I wonder how post-vaccine corticosteroids would work with pwME.. I definitely got flared up from being vaccinated and didn't bounce back prior to covid now crippling me entirely..
We still don't know if the post-vaccine effects are really due to an "overactive immune system" or if they actually represent an appropriate immune response to an existing, but silent, coronavirus infection. There are good arguments to be made on each side.

Just to be safe, I would personally opt for IVIG over corticosteroids...
 

pattismith

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We still don't know if the post-vaccine effects are really due to an "overactive immune system" or if they actually represent an appropriate immune response to an existing, but silent, coronavirus infection. There are good arguments to be made on each side.

Just to be safe, I would personally opt for IVIG over corticosteroids...
if the choice is given to you...of course!

I would be interested in reading the full text;

I'd like to know what kind of vaccine had the affected people (vector virus or pure RNA?)...

Edit:
I found the full text

Neuropathic symptoms with SARS-CoV-2 vaccination | medRxiv

A series of patients with a rare variant of Guillain-Barré syndrome with facial diplegia and paresthesia following the first dose of the AstraZeneca vaccine have been reported,2 and 3 of 11,636 participants in the ChAdOx1 nCoV-19 vaccine (AZD1222) trial developed transverse myelitis.3 One case of new onset small fiber neuropathy (SFN) and a second of postural orthostatic tachycardia syndrome (POTS) in previously healthy individuals were reported after receiving mRNA vaccines to SARS-CoV-2.4-6
The vaccines received included one manufactured by AstraZeneca (ChAdOx1 nCoV19),13 one by Janssen (JNJ-78436735), nine by Moderna (mRNA-1273)14 and 12 by Pfizer-BioNTech (BNT162b2).15 Fourteen participants (65%) developed neurological symptoms following the first dose. Among the 9 (39%) developing symptoms after the 2nd dose, four (17%) reported similar but mild and transient symptoms after their initial vaccination. Two had mild and transient elevation in ALT/AST post-vaccination and two had low-titer ANA and dsDNA antibodies that normalized on subsequent testing. Although none reported symptoms or a confirmed COVID-19 infection before vaccination, we detected antibody to SARS-CoV-2 nucleocapsid protein in one that we attributed to asymptomatic COVID-19.
 
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